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Objective: To assess the effectiveness of bone acupuncture in improving pain and function in degenerative lumbar spinal stenosis (DLSS) and compare it with Jiaji acupuncture., Methods: From January to December 2023, 80 DLSS patients were treated with acupuncture and divided into bone acupuncture and Jiaji acupuncture groups. Among them, 40 patients in the bone acupuncture group included 15 males and 25 females, with a mean age of (60.60±6.98) years old;anthor 40 patients in the Jiaji acupuncture group included 16 males and 24 females, with a mean age of (61.48±9.55) years old. The Roland Morris disability questionnaire(RMDQ), walking distance, visual analogue scale(VAS), and the MOS item short from health survey(SF-36) of two groups at baseline, 2 weeks, 4 weeks, and 12 weeks post-treatment were compared., Results: Eighty patients were followed up for 3 to 5 months with an average of (3.62±0.59) months. There was no significant differences in general data and the scores before treatment between two groups( P >0.05). The RMDQ scores in both groups decreased significantly at 2, 4 and 12 weeks after treatment compared with before treatment( P <0.05), at each time point after treatment, the decrease was more significant in the bone acupuncture group than in the Jiaji acupuncture group( P <0.05). The VAS of waist and leg in both groups was significantly lower at 2, 4 and 12 weeks after treatment that before treatment( P <0.05). At all time points after treatment, the waist VAS in the bone acupuncture group was reduced more significant than in the Jiaji acupuncture group( P <0.05);there was no significant difference in leg VAS at 2 and 12 weeks after treatment between two groups( P >0.05), the improvement was more significant in the bone acupuncture group in the 4 weeks after treatment than in the Jiaji acupuncture group. The SF-36 scores in both groups were significantly higher at 2, 4, and 12 weeks after treatment than before treatment( P <0.05);the SF-36 score raised more significant in the bone acupuncture group than in the Jiaji acupunture group( P <0.05). No significant difference in the walking distance between two groups at 2 weeks after treatment( P >0.05);the walking distance in the bone acupuncture group was significantly higher than that in the Jiaji acupuncture group at 4 and 12 weeks after treatment( P <0.05)., Conclusion: Bone-penetrating acupuncture moderately improves functional impairment, pain, and quality of life in patients with DLSS, showing better efficacy than Jiaji acupuncture.

Objective: To investigate the relevant factors for rupture of basilar tip aneurysms. Methods: This is a retrospective cohort study. Patients who underwent cerebrovascular digital subtraction angiography at Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University from July 2008 to February 2023 and were confirmed to have basilar tip aneurysms were retrospectively analyzed. There were 45 males and 56 females, aged (57.5±10.2) years (range: 36 to 76 years); the maximum diameter of the basilar tip aneurysm ( M (IQR)) was 6.85 (5.79) mm (range: 1.28 to 27.48 mm). Finally, 101 basilar tip aneurysms were included, and divided into two groups based on whether the basilar tip aneurysm ruptured or not. There were 37 cases (36.6%) in the ruptured group and 64 cases (63.4%) in the unruptured group. Data were analyzed using independent t -test, Mann-Whitney U test, chi-square test, or Fisher's exact test, as appropriate, and predictive factors for rupture of basilar tip aneurysms were explored by Logistic regression analysis. Variance inflation factors was used for analysis of collinearity. Results: The univariate results showed statistically significant differences between the ruptured and unruptured groups in terms of aneurysm neck width, basilar artery diameter, mean diameter of the parental artery, the ratio of neck width to parent artery diameter, aneurysm width and maximum diameter of the aneurysm (all P <0.05). In multivariate analysis, basilar artery diameter ( OR =0.347, 95% CI :0.176 to 0.687, P =0.002), and NRP ( OR =0.366, 95% CI :0.192 to 0.696, P =0.002) were predictive factors for rupture of aneurysms occurring at the basilar tip. There was no multiple covariance between NRP and basilar artery diameter in the analysis of covariance (VIF=1). Conclusion: Smaller basilar artery diameter and smaller NRP are relevant factors for rupture of basilar tip aneurysms.

Objective: To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma (IVMTE) and minimally invasive Mckeown resection of esophageal carcinoma (MIME) in early esophageal cancer. Methods: This is a retrospective cohort study. A retrospectively analysis was conducted on 176 patients with cT1N0M0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019. There were 128 males and 48 females, aged (66.4±7.7) years (range: 45 to 87 years). General data, perioperative outcomes, pathological data of the tumors, and complications were recorded. Independent sample t -test, χ ² test, or Wilcoxon rank-sum test was used to compare the data between the two groups. Propensity score matching was performed with gender, age, tumor location, differentiation degree, pT stage, pN stage, American Society of Anesthesiologists (ASA) classification, smoking history, and alcohol history were considered as covariates. The IVMTE group and MIME group were matched in a 1∶2 ratio using nearest neighbor match method with a caliper value of 0.02. Kaplan-Meier method was used to plot survival curves, with Log-rank test for univariate survival analysis. The Cox proportional hazards model was applied to analyze prognostic factors for overall survival, and subgroup stratification analysis was performed for pT stage. Results: After matching, the MIME group consisted of 54 cases, and the IVMTE group consisted of 27 cases. There were no statistically significant differences between the two groups in terms of gender, age, smoking history, alcohol history, ASA classification, tumor location, and other factors. The IVMTE group had shorter surgery time ( M (IQR), 220 (45) minutes vs. 245 (56) minutes, Z =2.950, P =0.003) and less intraoperative blood loss (100 (50) ml vs. 125 (100) ml, Z =2.193, P =0.028) compared to the MIME group. There were no differences between the two groups in the number and quantity of lymph node stations dissected, and the IVMTE group was not at a disadvantage in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (all P >0.05). The 1-, 3-, and 5-year overall survival (OS) rates and recurrence-free survival (RFS) rates were not significantly different between the two groups (all P >0.05). Subgroup analysis showed no significant difference in OS and RFS rates between the pT1 and pT2 subgroups (all P >0.05). Multivariate Cox regression analysis suggested that ASA classification ( HR =2.516, 95% CI : 1.126 to 5.624, P =0.025), pN stage ( HR =2.485, 95% CI : 0.984 to 6.274, P =0.046), and whether adjuvant therapy was given postoperatively ( HR =2.915, 95% CI : 1.304 to 6.515, P =0.009) were independent risk factors affecting 5-year OS rate. For 5-year RFS, pT stage ( HR =0.403, 95% CI : 0.194 to 0.838, P =0.011), pN stage ( HR =5.219, 95% CI : 2.401 to 11.346, P <0.01), and whether adjuvant therapy was given postoperatively ( HR =5.644, 95% CI : 2.691 to 11.838, P <0.01) were independent risk factors, while the surgical approach was not an independent risk factor affecting patient prognosis. Conclusion: The short-term and long-term effect of IVMTE in the treatment of early esophageal cancer is good, and it can achieve effects comparable to MIME.

Objective: To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma, and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids (ICS) combined with different long-acting bronchodilators. Methods: Data of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests (BDT), were retrospectively analyzed. These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms. According to fractional exhaled nitric oxide (FeNO) levels, patients were divided into type 2 inflammatory group [FeNO≥20 ppb (×10 -12 )] and non-type 2 inflammatory group (FeNO<20 ppb). Patients were further divided into ICS+long-actingβ2 agonist (LABA) group and ICS+LABA+long-acting anticholinergic agent (LAMA) group based on medication regimens. Patients were followed-up at the 3rd, 6th, and 12th months after enrollment to evaluate the patient's asthma control test (ACT) questionnaire, actual medication status and number of acute attacks. The clinical characteristics, treatment and prognosis of different groups were compared. Results: A total of 231 asthma patients were included, including 152 males and 79 females, with a age[ M ( Q 1 , Q 3 )] of 52 (42, 60) years. There were 144 cases (62.3%) in the nocturnal asthma group and 87 cases (37.7%) in the non-nocturnal asthma group. Among the 144 patients with nocturnal asthma, 133 patients completed FeNO testing, of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group. The eosinophil (EOS) count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group [(0.45±0.40) ×10 9 /L vs (0.25±0.20)×10 9 /L, 38 (18, 82) vs 29 (15, 48) ppb, both P <0.05]. Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group [16 (14, 18) vs 21 (19, 23) scores, P <0.001]. There was no significant difference in the forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), and peak expiratory flow (PEF) in the two groups (both P >0.05). During the follow-up at the 3rd, 6th, and 12th months, the improvement values of ACT scores (ΔACT) in the nocturnal asthma group were higher than the non-nocturnal asthma group [5 (3, 7) vs 2 (1, 3), 7 (4, 9) vs 3 (1, 4) and 7 (6, 9) vs 3 (1, 5) scores, all P <0.05]. The EOS count [0.40 (0.29, 0.80)×10 9 /L vs 0.20 (0.12, 0.29)×10 9 /L] and percentage [5.10% (3.55%, 9.10%) vs 2.20% (1.65%, 3.85%)] of the type 2 inflammation group were both higher than the non-type 2 inflammation group (both P <0.05). In the nocturnal asthma group, there was no significant difference in ΔACT between ICS+LABA and ICS+LABA+LAMA groups (both P >0.05). Conclusions: Patients with nocturnal asthma have more pronounced type 2 inflammation and the symptoms are often not well controlled or even worse. After one year of combined therapy with ICS, significant improvements in asthma symptoms can be observed. But there is no significant difference in symptom improvement among different medication regimens in the nocturnal asthma group.

A 68-year-old male developed foreign body sensation in both eyes, photophobia and tearing in the right eye approximately 6 weeks after initiating dupilumab for severe atopic dermatitis. The right eye presented a crescent-shaped superficial-stromal ulcer in the peripheral cornea with an undermined edge, which was separated from the limbus of the cornea by a clear zone. The left eye had a pannus at the limbus of the cornea. Corneal scraping, bacterial culture, and fungal culture excluded infections. The patient was administered 0.1% fluorometholone eye drops and recombinant bovine basic fibroblast growth factor eye drops. The patient's condition continued to improve during the follow-up period. At the revisit 82 days after the initial diagnosis, the corneal lesions of the right eye were basically healed, and the corrected visual acuity increased from 0.5 to 1.0.

This study investigated the mechanism of Chaishao Kaiyu Decoction in improving hippocampal neuroinflammation in depressed rats based on complement component 3(C3)/C3 receptor(C3aR). A total of 60 SD rats were randomly divided into a blank group, a model group, high, medium, and low dose groups of Chaishao Kaiyu Decoction, and a positive drug group, with 10 rats in each group. Except for the blank group, chronic unpredictable mild stress(CUMS) was used to construct depression models in other groups. Sucrose preference, open-field experiment, forced swimming, and water maze were used to detect the changes in depression-like behavior in each group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the serum inflammatory factor level in rats, and hematoxylin-eosin(HE) staining and Nissl staining were employed to observe the pathological damage of hippocampal neurons. Golgi-Cox staining was used to observe the dendritic spine damage of hippocampal neurons, and immunofluorescence and Western blot were utilized to detect the expression of microglial marker Iba-1 and C3/C3aR protein in the hippocampus of rats. The behavioral results showed that compared with the model group, Chaishao Kaiyu Decoction could significantly strengthen the sugar water preference, increase the distance and number of voluntary activities, shorten the immobility time in forced swimming and the successful incubation period of positioning navigation, and prolong the stay time of space exploration in the target quadrant. ELISA results showed that the content of inflammatory factors in the hippocampus of depressed rats was significantly higher than that of the blank group, and the content of inflammatory factors decreased significantly after the intervention of Chaishao Kaiyu Decoction. In addition, Chaishao Kaiyu Decoction could relieve pathological damage such as cell swelling and loose arrangement of hippocampus tissue. In the Western blot experiment, the expression levels of C3 and C3aR proteins in the model group were higher than those in the blank group, while the expression of C3 and C3aR in Chaishao Kaiyu Decoction could be down-regulated. Immunofluorescence results showed that compared with the model group, the fluorescence intensity of microglia marker Iba-1 decreased significantly after the intervention of Chaishao Kaiyu Decoction and positive drugs. The antidepressant effect of Chaishao Kaiyu Decoction may be related to the down-regulation of C3/C3aR signaling pathway-related proteins, thus alleviating hippocampal inflammation.

Objective: To investigate and compare the clinical efficacy and prognosis of D3 lymphadenectomy/complete mesocolic excision in treatment of right colon cancer with different medial boundaries. Methods: We searched The Cochrane Library, Pubmed, Embase, CBM, VIP, CNKI, and WanFang data bases for superior mesenteric artery (SMA)-oriented and superior mesenteric vein (SMV)-oriented D3 lymphadenectomy/complete mesocolic excision from inception to December, 2023. The resultant data were submitted to meta-analysis using RevMan 5.3 software. Results: In total, we identified nine eligible studies involving 2467 patients. The SMA group had 982 patients and the SMV group had 1 485 patients. Meta-analysis revealed no significant differences in intraoperative bleeding volume, postoperative time to passage of flatus, or postoperative drainage volume between the two studied approaches. The durations of surgery and of postoperative hospital stay were both significantly longer in the SMA than SMV group (weighted mean difference [WMD]=17.70, 95%CI: 6.90-28.50, P =0.001; WMD=0.40, 95%CI: 0.07-0.72, P =0.020, respectively). Furthermore, the rate of postoperative complications was greater in the SMA than SMV group. For example, the incidences of postoperative chyle leakage and diarrhea were significantly higher in the SMA than SMV group, (OR=1.25, 95%CI: 1.01-1.54, P = 0.040; OR=3.60, 95%CI: 2.39-5.41, P < 0.001; OR=2.13, 95%CI: 1.10-4.11, P = 0.020, respectively). In terms of oncological efficacy, the total number of lymph nodes dissected and the number of positive lymph nodes in the SMA group were significantly higher than in the SMV group (WMD=2.76, 95%CI:1.22-4.31, P < 0.001, WMD=0.59, 95%CI: 0.06-1.12, P = 0.030). Conclusion: Laparoscopic surgery for right colon cancer, using the left margin of the SMA as the medial boundary for dissection is associated with a higher risk of postoperative complications, such as chyle leakage and diarrhea, than is using the superior mesenteric vein as the medial boundary. The durations of surgery and postoperative hospital stay are longer. SMA left margin dissection has significant oncological advantages, including a higher total number of harvested lymph nodes and of positive lymph nodes.

Objective: This study aimed to primarily discuss the pathogenesis of hereditary coagulation factor Ⅴ (FⅤ) deficiency in a family with a consanguineous cousin marriage. Methods: The coagulation indices of the pedigree (three generations with seven individuals) and the thrombin levels of the proband and his father were assessed. All exons of the F5 gene were analyzed with Sanger sequencing, and a new mutation was confirmed with reverse sequencing. The corresponding sites of the family members were then determined. A set of online software was utilized to predict the conservation and pathogenicity of the mutation site. The pathogenicity of this mutation site was evaluated according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Results: The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the proband were 52.2 s and 108.3 s, respectively. FⅤ activity (FⅤ∶ C) and FⅤ antigen (FⅤ∶Ag) were greatly decreased by 2% and 4%, respectively. The problem was diagnosed as type Ⅰ F Ⅴ deficiency. PT and APTT of the proband's father, mother, and grandfather were slightly higher than the upper limit of the reference range, and FⅤ∶C and FⅤ∶Ag were approximately 50% of normal. The thromboplastin generation assay revealed that the amount of thromboplastin produced by the proband and his father was lower than that of the healthy controls and that the proband's ability to produce thromboplastin was more severely impaired. Sequencing analysis revealed that the proband demonstrated a homozygous missense mutation of c.5128T > C (p.Trp1682Arg) in exon 15 of the F5 gene. The grandfather, father, and mother of the proband were all heterozygous for c.5128 T > C. Conservative analysis revealed that p.Trp1682 was a highly conserved site in the homozygous species, and five online software programs, including Mutation Taster, SIFT, REVEL, PolyPhen-2, and CADD, indicated that the mutation was pathogenic. The ACMG guidelines recommend that the new mutation c.5128 T > C is a possible pathogenic mutation (PM2 + PM3 + PP1 + PP3 + PP4). The comparison of the protein models before and after the mutation revealed that the benzene ring and the hydrogen bond were reduced after the mutation, which changed the local structure of the F Ⅴ protein. Conclusion: The missense mutation c.5128T > C (p. Trp1682Arg) in exon 15 of the F5 gene was initially considered the genetic cause of the FⅤ deficiency family. This mutation is the first report globally, which further enriches the gene-phenotype spectrum of FⅤ deficiency.

Peri-implantitis is one of the most common biological complications after implant restoration which is difficult to be cured. Early and correct diagnosis is of great significance for the prevention and treatment of peri-implantitis. Although there have been consensus reports to make guiding suggestions in diagnosis, the diagnostic criteria are not uniform, resulting in many confusions. This review summarizes published consensuses on the diagnosis of peri-implantitis, analyzes the diagnostic values and limitations of traditional examination methods, and summarizes the recent advances in examination methods for peri-implant soft and hard tissues, aiming to provide a reference for clinical diagnosis of peri-implantitis.

To analyze the source apportionment, potential ecological risk, and health risk of heavy metals in soils surrounding a manganese tailings pond in Chongqing, a positive matrix factorization （PMF） model, potential ecological risk index, and health risk assessment model were used. Further, all three models were combined to explore the risks of heavy metals in soils by different pollution sources to determine the priority control factors. The results showed that except for the Cr concentration, the average values of Mn, Cd, As, Pb, Cu, Zn, and Ni concentration were higher than their corresponding background values. Using the PMF model analysis, mining, natural, agricultural, and industrial sources were identified as the determinants for the accumulation of heavy metals in soils, with contribution rates of 23.9%, 30.2%, 18.8%, and 27.1%, respectively. Using potential ecological risk index analysis, the ecological risk was predominantly categorized as "strong" risk, with the rate of 77.8%. The health risk assessment model analysis revealed that, the carcinogenic risks of adults and children were tolerable, whereas the non-carcinogenic risks were acceptable. According to the analysis results of the relationship among heavy metals, pollution sources, potential ecological risk, and health risks showed that agricultural sources were identified as the priority control sources, with Cd as the primary control factor. Mining sources and industrial sources were identified as secondary control sources, with Mn and As as the secondary control factors.

To analyze the source apportionment and influence factors of heavy metals in soils surrounding a coal gangue heap in Chongqing, the absolute principal component scores-multiple linear regression （APCS-MLR） model and GeoDetector were used. The results showed that Cd was the primary pollutant and the average values of Cd, Hg, Pb, Cr, Cu, Zn, and Ni were 1.33, 0.29, 32.9, 142, 68.8, 118, and 54.6 mg·kg -1 , respectively. Using the APCS-MLR model analysis, mining sources, which were mainly affected by long-term accumulation of the coal gangue heap, had a contribution rate of 37.1% and the main heavy metal pollutants were Cd, Hg, and Pb. Agriculture and transportation sources, mainly affected by pesticide and fertilizer application and vehicle emissions, had a contribution rate of 36.2%, with the main heavy metal pollutants being Cu, Zn, and Ni. Natural sources, which were mainly affected by geotechnical weathering processes of their parent materials, had a contribution rate of 26.7% and the main heavy metal pollutant was Cr. Using GeoDetector analysis, the "distance from coal gangue heap" had the strongest explanatory power for the contents of Cd, Hg, and Pb, whereas the "distance from rural settlements" had the strongest explanatory power for the contents of Cr, Cu, Zn, and Ni. However, the interaction of each influencing factor was enhanced, which indicated that the spatial distribution characteristics of heavy metals were influenced by multiple factors. The combined application of the APCS-MLR model and GeoDetector can make the results of source apportionment and influence factors more comprehensive, accurate, and reliable.

Objective: To summarize the clinical phenotype and genetic characteristics of deficiency in ELF4 gene X-linked (DEX). Methods: A case series study was conducted to retrospectively analyze the clinical data and genetic testing results of 2 cases of DEX treated at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and the First Hospital of Jilin University from January 2023 to April 2024. And literature up to April 2024 was searched from the PubMed database, as well as CNKI and Wanfang databases, using keywords such as "ELF4 deficiency" "deficiency in ELF4, X-linked""ELF4 gene". The main clinical manifestations and genotypes of DEX were summarized. Results: Both patients were male, with onset ages of 3 months and 3 years, respectively. Both patients presented with recurrent oral ulcers and abdominal pain. And the laboratory examination showed a significant increase in inflammatory markers. Intestinal examinations showed multiple intestinal ulcers, and both patients developed intestinal fistulas. Whole exome sequencing found ELF4 c.799C>T, p Arg267Trp and ELF4 c. 248-7G>A, both maternal variants. Based on clinical and genetic results, DEX were diagnosed. In terms of treatment, both patients underwent surgical treatment during the acute phase of the disease and received anti-tumor necrosis factor α therapy, but recurrent gastrointestinal symptoms were still observed in Patient 1, while the clinical effect in Patient 2 was still acceptable. However, the inflammatory markers in both patients were not normal even after treatment. Literature review found 18 patients including 2 patients in this study, reported in 5 English articles and no Chinese reports. Thirteen patients had disease onset age before 5. The main clinical manifestations were fever (12/17), oral ulcers (14/18), abdominal pain (8/18), diarrhea (6/18), perianal ulcers (5/17), ileum ulcers (6/16), colon ulcers (7/16), skin involvement (7/17) and recurrent infections (7/18); laboratory examinations found increased erythrocyte sedimentation rate (13/15) as well as C-reactive protein (9/9), and anemia (13/15); in terms of immunological function, there is a decrease in natural killer cells (9/15) as well as a decrease in class switching memory B cells (8/9). The main types of gene variantions were missense variantions (6/18), nonsense variantions (4/18) or frameshift variantions (3/18). Conclusions: DEX should be considered when an early-onset male patient manifested with recurrent fever, oral ulcers or mucosal ulcers, with elevated inflammatory markers, with or without recurrent infection. It is recommended to perform lymphocyte subsets analysis, gastrointestinal endoscopy and genetic testing to support the diagnosis.

Background: After the Coronavirus disease 2019 (COVID-19) pandemic, international medical services have continued to flourish and reconfigure, leading to the current intense competition among medical institutions. Understanding loyalty in international patients and its related factors may be referenced and used to enhance loyalty among patients visiting a hospital, thereby enhancing the competitiveness of that medical institution., Purpose: This study was designed to explore the significant factors that influence the loyalty of international patients., Methods: The international medical services patient database of a northern medical center was used to extract information on patients who had received services from the international medical center between 2018 and 2022 (n = 3,325). Binary logistic regression analysis was used to calculate the increase in patient loyalty at each quartile, the estimated relative odds ratio (OR) of international patient loyalty, and its 95% confidence interval (CI). Potentially relevant factors controlled in the statistical model included: age, source of information from the unit, and total medical expenses., Results: This study found that the level of international medical service patient loyalty to the target hospital averaged approximately 15.1%. International medical service patient loyalty differed significantly by age group (45-64 years old), using non-internet sources for information, and spending at least 1 million NT dollars on medical expenses (p < .001). The information source used (OR: 1.72; p < .001; 95% CI [1.33, 2.23]) and total medical expenses (OR: 4.56; p < .001; 95% CI [3.49, 5.95]) were identified as significant predictors of loyalty., Conclusions / Implications for Practice: It is hoped the results of this study provide a reference for institutions to promote international medical services, improve international competitiveness, and demonstrate the quality of medical care provided in Taiwan.

The application of exogenous substances has important effects on soil greenhouse gas emissions and phytoremediation of soil contaminated by heavy metals. Pennisetum americanum × Pennisetum purpureum and Helianthus annuus were used as remediation plants in this study. The effects of different exogenous substances on phytoremediation and greenhouse gas emissions of heavy metal-contaminated soil were studied. The results showed that the application of exogenous substances had little effect on the pH value of P. americanum × P. purpureum soil but significantly reduced the pH value of H. annuus soil compared with that of the background soil. The application of potassium fertilizer （KCl） increased the biomass of plants, enhanced the activities of superoxide dismutase （SOD） and peroxidase （CAT）, and improved the stress resistance of H. annuus . The application of gibberellin （GA 3 ） and indole butyric acid （IBA） decreased the antioxidant enzyme activity and the content of malondialdehyde （MDA） and alleviated the stress of heavy metals in H. annuus. The KCl and EDDS treatments affected the accumulation of Cd and Pb in plants, respectively. The application of KCl significantly increased the accumulation of Cd in P. americanum × P. purpureum and H. annuus and the accumulation of Cd in P. americanum × P. purpureum roots, and the application of EDDS significantly increased the accumulation of Pb in H. annuus shoots and H. annuus roots. Compared with those in the CK treatment, the application of KCl and EDDS could reduce the cumulative CO 2 emissions in soil, which were 20.4% and 5.0% in P. americanum × P. purpureum planting soil and 15.8% and 45.9% in H. annuus planting soil, respectively. However, the application of GA 3 and IBA could increase the cumulative CO 2 emissions. Exogenous substance treatment increased the cumulative N 2 O emissions of P. americanum × P. purpureum soil but decreased the cumulative N 2 O emissions of H. annuus soil to different degrees. Compared with those in the CK treatment, the application of KCl and GA 3 significantly reduced the cumulative N 2 O emissions of H. annuus by 40.5% and 43.5%, respectively. The application of EDDS and IBA reduced the cumulative N 2 O emissions by 20.1% and 28.4%, respectively. In conclusion, the application of GA 3 and IBA alleviated the heavy metal stress of H. annuus , and the KCl and EDDS treatments enhanced phytoremediation efficiency and reduced soil greenhouse gas emissions to varying degrees.

Benign prostatic hyperplasia(BPH) is a common disease in middle-aged and elderly men, with lower urinary tract symptoms as the main manifestation, severely affecting the quality of life of patients. The pathogenesis of BPH is not yet fully understood, and there are still some challenges and limitations in western medicine treatment for BPH. Therefore, finding new and more effective treatment strategies is urgent. In recent years, many basic and clinical studies have confirmed the important role of traditional Chinese medicine in the treatment of BPH. This article reviews the progress of basic and clinical research in the treatment of BPH with traditional Chinese medicine, and believes that basic research mainly focuses on the active ingredients of Chinese medicine [regulating pathways such as NF-E2-related factor 2(Nrf2)/antioxidant response element(ARE), nuclear factor κB(NF-κB), epidermal growth factor receptor(EGFR)/signal transducer and activator of transcription 3(STAT3), phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR), p38 mitogen-activated protein kinase(p38 MAPK)/forkhead box O subtype(FOXO3a), etc.], single Chinese herbs(regulating inflammatory factors, oxidative stress-related proteins, cell cycle-related proteins, and apoptotic factors, etc.), and Chinese herbal compounds and patent medicines [regulating extracellular signal-regulated kinase(ERK1/2), transforming growth factor-β(TGF-β)/Smad, mitogen-activated protein kinase(MAPK), PI3K/Akt, Nrf2, trefoil factor 2(TFF2)/Wnt, interleukin-6(IL-6)/Janus kinase 2(JAK2)/STAT3, hypoxia-inducible factor 1α(HIF-1α)/vascular endothelial growth factor receptor(VEGFR), etc.], and then play a therapeutic role by inhibiting BPH cell proliferation, oxidative stress, inflammatory response, promoting apoptosis, and inhibiting epithelial-mesenchymal transition. Clinical studies mainly focus on internal treatment, external treatment, combined internal and external treatment, and integrated Chinese and western medicine treatment as the main methods, aiming to improve traditional Chinese medicine syndrome scores, prostate symptom scores, residual urine volume, effective bladder volume, sexual quality of life, increase average urine flow rate, maximum urine flow rate, and promote balance of sex hormone secretion. Through this research, it is hoped to provide some reference ideas for clinical research and drug development for BPH.

The clinical data of 33 patients who underwent robot-assisted laparoscopic Vattikuti Institute prostatectomy (VIP) in Cancer Hospital of Chinese Academy of Medical Sciences from October 2020 to April 2022 were reviewed and analyzed. Among them, 18 patients received traditional VIP technique and 15 patients received VIP technique with pre-sutured dorsal venous complex (DVC). The ages of the traditional VIP group and the pre-sutured DVC VIP group were (66.1±7.3) and (66.6±5.7) years, respectively. The body mass index (BMI) of the traditional VIP group and the pre-sutured DVC VIP group was (24.3±2.9) and (25.3±2.6) kg/m 2 , respectively. The medical expenses were (91 797.0±7 029.6) and (87 106.6±7 031.4) yuan, respectively, with no statistical significance (all P >0.05). The operations of all the 33 cases were successfully completed, and no cases were transferred to open surgery. The operation time of traditional VIP group was longer than that of pre-sutured DVC VIP group [(193.0±37.2) vs (171.1±16.1) min]. The amount of intraoperative blood loss was higher than that in the pre-sutured DVC VIP group [(68.3±22.8) vs (44.0±9.1) ml)], all P <0.05. No patients had perioperative blood transfusion, and no patients had complications within 30 days after surgery. All the 33 patients had negative incisal margins. DVC presuture technique can reduce intraoperative bleeding and shorten operative time in robot-assisted laparoscopic VIP radical prostatectomy, and has good curative effect.

Background: End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents' physical and mental health., Purpose: This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care., Methods: A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants., Results: Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results., Conclusions / Implications for Practice: Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.

Quantitative evaluation of urban ecological carrying capacity is a critical foundation for measuring urban sustainable development in the new era. This review would enrich the concept and connotation of urban ecological carrying capacity by sorting out its components and characteristics. We categorized the methods for quantifying urban ecological carrying capacity into static evaluation methods, including ecological footprint method, comprehensive evaluation method, state space method, net primary productivity method, and carbon-oxygen balance method, as well as dynamic simulation prediction methods, including system dynamics models, BP neural network prediction models, and grey prediction models. We further summarized both the advantages and disadvantages of these quantitative evaluation methods. Finally, we predicted the development trends of quantitative evaluation methods for urban ecological carrying capacity, and put forward further in-depth research from aspects such as strengthening theoretical foundations, constructing indicator systems, establishing evaluation principles, and optimizing methods.

Objective: To investigate the mechanism of DNA damage and repair in MLL -rearranged acute myeloid leukemia（ MLL -r AML）cells by the combination of Chidamide and the BRD4 inhibitor(+)-JQ-1., Methods: MLL -r AML cell lines Molm-13, MV4-11 and non- MLL -r AML cell line Kasumi were divided into control group（contr）, Chidamide group（chida）, (+)-JQ-1 group and Combination group（combi）, respectively. Cell viability of Molm-13 was measured by CCK-8 to determine optimal the concentrations of Chidamide and(+)-JQ-1. The cell cycle was detected by flow cytometry, and apoptosis-related factors Bcl-2, Bax and caspase-3 were detected by Western blot. DNA damage marker γH2AX was detected by immunofluorescence. The protein expressions of DNA damage factor γH2AX, DNA damage checkpoint kinases p-ATR, p-CHK1, p-ATM, p-CHK2 and DNA damage repair factors Rad51 and 53BP1 were detected by Western blot. The expression of DNA damage repair factors Rad51 and 53BP1 mRNA was detected by qRT-PCR., Results: Under the treatment of Chidamide (300 nmol/L) and (+)-JQ-1 (400 nmol/L), the proportion of G 1 phase cells in MLL -r AML cell lines Molm-13 and MV4-11 was increased in combination group compared with control group. In non- MLL -r AML cell line Kasumi, compared with control group, the proportion of G 1 phase cells in combination group was increased ( P < 0.05). In Molm-13 and MV4-11 cell lines, compared with control group, the expression level of DNA damage marker γH2AX in combination group was increased ( P < 0.05). The expression levels of DNA damage checkpoint and damage repair factors p-ATR, p-CHK1, p-ATM, p-CHK2, Rad51, 53BP1 were decreased ( P < 0.05). In Kasumi cell line, compared with control group, there was no significant change in the expression of some of the above factors in combination group ( P >0.05), but the expression trend of some factors was opposite. In MLL -r AML cell lines Molm-13 and MV4-11, compared with control group, the expression levels of Bax and caspase-3 protein were increased in combination group, while the expression levels of Bcl-2 protein were decreased ( P < 0.05). In non- MLL -r AML cell line Kasumi, there was no significant change in apoptotic factor protein expression in combination group compared with control group ( P >0.05)., Conclusion: Chidamide combined with (+)-JQ-1 can inhibit the proliferation of MLL -r AML cells, inhibit the initiation of protective self-repair of these leukemia cells by inhibiting the DNA damage response pathway, and ultimately increase the apoptosis of these cells, but non- MLL -r AML cells have no similar results.

Objective: To understand the incidence trend of meningococcal meningitis from 1990 to 2023 and major pathogenic serogroups of Neisseria ( N. ) meningitidis from 2006 to 2023 in China and the time trend of the incidence of meningococcal meningitis caused by main pathogenic serogroups, and provide reference for the prevention and control of meningococcal meningitis. Methods: The study used the data from "National Epidemic Data Compile" from 1990 to 2003 and the data from China Notifiable Infectious Disease Reporting System from 2004 to 2023 to analyze the incidence trend of meningococcal meningitis in China from 1990 to 2023 by Joinpoint regression method. Based on the data of the national meningococcal meningitis surveillance information reporting and management system from 2006 to 2023, the incidence of meningococcal meningitis caused by different serogroups of N. meningitidis was described and analyzed, and the trend χ 2 test was performed to analyze the change of the incidence of meningococcal meningitis caused by N. meningitidis A, B, and C. Results: The overall incidence of meningococcal meningitis in China showed a downward trend from 1990 to 2023 [average annual percent change (AAPC)=-14.80%, P <0.001], with the most obvious decline from 2005 to 2012 [annual percent change (APC)=-31.01%, P <0.001]. The incidence of meningococcal meningitis decreased in both men and women (AAPC=-14.69% and -15.05%, both P <0.001). A total of 1 178 serogroup specific cases of meningococcal meningitis were reported in China from 2006 to 2023, the proportion of serogroup C was highest (32.5%), followed by unclassified (22.3%), B (20.1%), A (18.4%), W (4.5%), Y (2.0%) and X (0.2%). The results of trend χ 2 test indicated that the incidence of meningococcal meningitis caused by N. meningitidis A and C showed downward trends (both P <0.001) and the incidence of meningococcal meningitis caused by N. meningitidis B showed an upward trend in general population and young children (0-4 years old group) from 2006 to 2023 (both P <0.05). Conclusion: The incidence of meningococcal meningitis showed a downward trend in China from 1990 to 2023, but it is still necessary to pay more attention to the incidence of meningococcal meningitis caused by N. meningitidis B in age group aged 0-4 years and by multi serogroups at same time in general population.

Aldosterone-producing adenoma is a subtype of primary aldosteronism. Recent advancements in multi-omics research have led to significant progress in understanding primary aldosteronism at the genetic level. Among the various genes associated with the development of aldosterone-producing adenomas, the KCNJ5 (potassium inwardly rectifying channel, subfamily J, member 5) gene has received considerable attention due to its prevalence as the most common somatic mutation gene in primary aldosteronism. This paper aims to integrate the existing evidence on the involvement of KCNJ5 gene in the pathogenesis of aldosterone-producing adenomas, to enhance the understanding of the underlying mechanisms of aldosterone-producing adenomas from the perspective of genetics, and to provide novel insights for the clinical diagnosis and treatment of aldosterone-producing adenomas.

The effectiveness of game-based learning strategies lies in the ability of these strategies to engage learners and enhance their motivation to learn. This is particularly important for today's younger generations, which are known to respond better to visual rather than textual information. Gamified education provides stimulating, realistic, and enjoyable learning experiences, helping students understand complex nursing knowledge and skills. The diversity of game-based learning tools, including based board games, escape room games, digital games, simulation games, mobile serious games, and virtual reality games, not only enhances students' learning effectiveness and skills but also improves their problem-solving abilities, communication skills, and ability to cope with various challenges in clinical care. In general, game-based learning is a strategy with great potential and importance. This strategy not only has profound implications for modern nursing education and clinical practice but also, through its promotion of innovative thinking and diversified applications, can effectively promote the learning motivation of nursing professionals, improve teaching effectiveness, and enhance professional abilities and self-directed learning capabilities. In an era in which medical knowledge is constantly evolving, game-based learning should be promoted and utilized to cultivate nursing professionals' capabilities effectively.

Based on the hepatocyte growth factor(HGF)/phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling axis, this study investigated the therapeutic effect of Paeoniae Radix Rubra and Aconiti Lateralis Radix Praeparata(PRR-ALRP) her-bal pair on acute-on-chronic liver failure(ACLF) rats and its impact on hepatocellular regeneration. The rat model of ACLF was constructed by subcutaneous and tail vein injection of bovine serum albumin combined with intraperitoneal injection of lipopolysaccharides(LPS)+D-galactosamine(D-GalN). The rats were divided into normal control(NC) group, model(vehicle) group, PRR-ALRP(5.85 g·kg~(-1)) group, and hepatocyte growth factor granules(HGFG, 4.05 g·kg~(-1)) group. Hematoxylin-eosin(HE) staining was used to observe pathological changes in rat liver tissues. Serum alanine aminotransferase(ALT), aspartate transaminase(AST), and total bilirubin(TBIL) were detected using an automatic biochemical analyzer. The levels of interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) inflammatory factors were detected by ELISA. Immunofluorescence staining was used to detect the positive expression of proliferating cell nuclear antigen(PCNA), antigen identified by monoclonal antibody(Ki67), and cell cycle protein B1(CyclinB1). Real-time fluorescence-based quantitative polymerase chain reaction(RT-qPCR) and Western blot were used to detect the mRNA and protein expression levels of HGF, growth factor receptor-bound protein 1(Gab1), PI3K, Akt, phosphorylated PI3K(p-PI3K), and phosphorylated Akt(p-Akt). The results showed that compared with the vehicle group, the PRR-ALRP group had reduced liver tissue pathological scores, improved liver function, and reduced inflammatory response, with enhanced PCNA, Ki67, and CyclinB1 fluorescence expression. Furthermore, compared with the model group, the PRR-ALRP group showed upregulated expression of HGF and Gab1 proteins, as well as activation of PI3K and Akt phosphorylation. These findings suggest that PRR-ALRP herbal pair exerts anti-liver failure effects by alleviating hepatocyte inflammatory damage and promoting hepatocellular regeneration, and its specific regulatory mechanism may be related to the activation of the HGF/PI3K/Akt signaling pathway.

Evaluation of neobladder function in patients with long-term survival and no recurrence after laparoscopic radical cystectomy and intracorporeal Xing's neobladder. The clinical data of laparoscopic radical cystectomy and intracorporeal Xing's neobladder in long-term survival patients with bladder cancer treated in Beijing Chaoyang Hospital from July 2013 to July 2018 were analyzed retrospectively. All 17 patients underwent the surgery by the same surgical team, including 15 males and 2 females, whose mean age at the time of operation was (55.9±7.6) years. Thepostoperative urinary function and renal function were summarized. All operations were successfully completed. The mean operative time was (340±62) min. All patients were followed up for a long time, with a median follow-up time of 80(70, 96) months, Urinary continence was achieved in 17 (100%)casesduring the day and 13 (76.5%) cases at night, with a median bladder volume of 350 (200, 400) ml. All patients had good urinary control after surgery, and no hydronephrosis or creatinine increase was found in reexamination.After the application of Xing's neobladder operation, the patient maintained acceptable urinary control status after the operation, and the long-term follow-up effect was satisfactory.

Objective: To explore the MRI characteristics of the hepatic epithelioid hemangioendothelioma (HEHE) classification according to morphology and size. Methods: The clinical, pathological, and MRI imaging data of 40 cases with HEHE confirmed pathologically from December 2009 to September 2021 were retrospectively analyzed. A paired sample t -test was used for comparison between the two groups. Results: There were 40 cases (5 solitary, 24 multifocal, 9 local fusion, and 2 diffuse fusion) and 214 lesions (163 nodules, 31 masses, and 20 fusion foci). The most common features of lesions were subcapsular growth and capsular depression. The signal intensity of lesions ≤1cm was usually uniform with whole or ring enhancement. Nodules and mass-like lesions ≥1cm on a T1-weighted image had slightly reduced signal intensity or manifested as a halo sign. Target signs on a T2-weighted image were characterized by: target or centripetal enhancement; fusion-type lesions; irregular growth and hepatic capsular retraction, with ring or target-like enhancement in the early stage of fusion and patchy irregular enhancement in the late stage; blood vessels traversing or accompanied by malformed blood vessels; focal bleeding; an increasing proportion of extrahepatic metastases and abnormal liver function with the type of classified manifestation; primarily portal vein branches traversing; and reduced overall intralesional bleeding rate (17%). Lollipop signs were presented in 19 cases, with a high expression rate in mass-type lesions (42%). The fusion lesions were expressed, but the morphological manifestation was atypical. The diffusion-weighted imaging mostly showed high signal or target-like high signal. An average apparent diffusion coefficient of lesions was (1.56±0.36) ×10(-3)mm(2)/s, which was statistically significantly different compared with that of adjacent normal liver parenchyma ( t =8.28, P <0.001). Conclusion: The MRI manifestations for the HEHE classification are closely related to the morphology and size of the lesions and have certain differences and characteristics that are helpful for the diagnosis of the disease when combined with clinical and laboratory examinations.

This study aimed to investigate the impact of spatiotemporal changes in land use on ecosystem carbon storage. The study analyzed the spatiotemporal changes in carbon storage in the study area based on land use data from five periods (1985, 1995, 2005, 2015, and 2020) using the InVEST model. The PLUS model was used to predict land use changes in the study area under four different scenarios (natural development, farmland protection, ecological protection, and double protection of farmland and ecology) in 2035, and the ecosystem carbon storage under different scenarios was estimated. The results of the study indicated that the farmland in the area under investigation had been decreasing consistently from 1985 to 2020, with a more rapid rate of change observed between 2015 and 2020. During this period, the overall dynamic attitude towards land use reached 34.62 %. Additionally, the carbon storage in the area showed a decreasing trend over the years, with a decrease of 1.55×10 5 t from 1985 to 2020. Between 2005 and 2015, the carbon storage showed a decrease of 1.22×10 5 t, with an average annual decrease of 1.22×10 4 t. The areas with higher carbon storage were located in the eastern part of the study area, whereas areas with lower carbon storage were found in the central and northwestern parts. Although the proportion of carbon storage in farmland decreased from 66.89 % to 57.73 %, farmland remained the most important carbon pool in the study area. The conversion of other land use types to grassland and forestland was advantageous for increasing ecosystem carbon storage. Finally, the study projected that by 2035, the carbon storage in the natural development scenario, the farmland protection scenario, the ecological protection scenario, and the dual protection scenario would be 81.77×10 5 , 82.45×10 5 , 82.82×10 5 , and 82.51×10 5 t, respectively.

Objective: To investigate the safety, efficacy and effective dose of empagliflozin in the treatment of glycogen storage disease type Ⅰb (GSD Ⅰb). Method: This was a cross sectional study. A total of 28 children with GSDⅠb who started oral empagliflozin treatment from January 2021 to June 2023 in the WeChat group of patients with glycogen storage disease were selected as the study objects. Clinical data such as general situation, current situation of medication and adverse reactions of the children were collected through questionnaires from June 18 to 30, 2023. The differences of symptoms and laboratory tests before and after empagliflozin treatment were compared by using paired chi-square test and Wilcoxon signed rank sum test. Results: Totally 28 children with GSD Ⅰb were from 12 different provinces, autonomous regions and municipalities in China. There were 14 males and 14 females. Empagliflozin treatment was started at the age of 4.8 (2.4, 10.8) years, the time of treatment was 14.5 (11.3, 21.5) months, the initial dosage was (0.23±0.11) mg/(kg·d), and the maintenance dosage was (0.28±0.12) mg/(kg·d). Empagliflozin showed positive effects on neutropenia, severity of inflammatory bowel disease like symptoms( Z =-3.70 , - 2.65, both P <0.05), The proportion of recurrent oral ulcers, recurrent bacterial infections and anemia was significantly lower than that before medication (18% (5/28) vs. 46% (13/28), 14% (4/28) vs. 46% (13/28), 21% (6/28) vs. 46% (13/28), χ ²=4.05, 5.26, 3.05 , all P <0.05). Granulocyte colony-stimulating factor (GCSF) was once used in 5 children with GSD Ⅰb, all of them had completely stopped GCSF after empagliflozin treatment. The most common adverse events during empagliflozin treatment were hypoglycemia (5 children) and urinary infection (3 children). All 28 patients had no serious adverse reactions. Conclusions: Empagliflozin can increase the neutrophil count of children with GSD Ⅰb, and had a favorable effect on symptoms such as recurrent oral ulcers, and recurrent infection. The common adverse events during empagliflozin treatment were hypoglycemia and urinary infection.

Nursing information systems are becoming increasingly prevalent in our medical institutions. However, changes in the social environment and imbalances between the demands of caregivers and care recipients mean that current nursing information systems are inadequate in terms of quality and operational needs. This article was written to provide insights into opportunities to leverage technology to further promote care quality by applying a "data, information, knowledge, and wisdom" system development structure to develop intelligent technology products that equitably meet the needs of patients, caregivers, and nursing processes. Applied in clinical settings, these products should help satisfy patient needs and facilitate nursing work.

Objective: To explore the magnetic resonance imaging (MRI) features and classification of intraductal papillary neoplasm of the bile duct (IPNB). Methods: Data from 90 patients with intraductal papillary neoplasm of the bile duct confirmed pathologically between June 2010 and January 2023 were retrospectively analyzed. The image analysis included the shape and location of the tumor, whether bile ducts had dilatation and the degree of dilation, whether there was a history of liver disease, whether there was a history of schistosomiasis, whether there was cancerous transformation, whether there were concurrent bile duct stones, whether there was hepatic lobe atrophy, whether there was hilar or abdominal lymph node enlargement, whether there was invasion of the bile duct wall, whether there was invasion of surrounding blood vessels, whether the tumor appears on T1-and T2 weighted imaging (T(1)WI and T(2)WI), whether the diffusion was limited, whether there was concurrent bleeding, enhancement rate, and whether there was abdominal fluid accumulation. Intraductal papillary neoplasms of the bile duct were divided into four types according to the morphological classification standards: type I (local bile duct dilation), type II (cystic), type III (free tumor), and type IV (dilated bile duct). The differences in the clinical and MRI features of the four groups of lesions were analyzed. Statistical analysis was performed with a t -test, an analysis of variance, and an χ (2)-test according to the different data. Results: Among the 90 cases with hepatic IPNB, there were 31 cases of type I, 15 cases of type II, 16 cases of type III, and 28 cases of type IV, 41 cases of liver left lobe, 11 cases of right and left lobe liver span, 7 cases of liver right lobes, 2 cases of liver caudate lobe, and 13 cases of hepatic hilar. There were statistically significant differences between the four groups ( P  < 0.05) in terms of age, clinical symptoms, direct bilirubin, γ-glutamyltransferase, whether they were cancerous, whether they were combined with bile duct stones, whether the liver lobes were atrophying, whether there was limited diffusion, intrahepatic bile duct diameter, and common bile duct diameter. However, there were no statistically significant differences among the four groups in gender, location, carbohydrate antigen 19-9, history of liver disease, history of schistosomiasis, carcinoembryonic antigen, alanine aminotransferase, aspartate aminotransferase, total bilirubin, whether hemorrhage was associated, lesion enhancement rate, whether the hilar/retroperitoneal lymph node was enlarged, whether the bile duct wall was invaded, whether blood vessels were invaded, and whether abdominal fluid was accumulated ( P  > 0.05). Conclusion: MRI manifestations have certain features for different types of intraductal papillary neoplasm of the bile duct tumors; hence, MRI aids in the diagnosis and differential diagnosis of this disease.

The evolution of critical care medicine is inextricably linked to the development of critical care procedures. These procedures not only facilitate diagnosis and treatment of critically ill patients, but also provide valuable insights into disease pathophysiology. While critical care interventions offer undeniable benefits, the potential for iatrogenic complications necessitates careful consideration. The recent surge in critical care ultrasound (US) utilization is a testament to its unique advantages: non-invasiveness, real-time bedside availability, direct visualization of internal structures, elimination of ionizing radiation exposure, repeatability, and relative ease of learning. Recognizing the need to optimize procedures and minimize complications, critical care utrasound study group of Beijing critical care ultrasound research assocition convened a panel of critical care experts to generate this consensus statement. This document serves as a guide for healthcare providers, aiming to ensure patient safety and best practices in critical care.

Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) is a common urological disease with complex etiology. The treatment effect of western medicine is not satisfactory, and the course of the disease is protracted, which brings great trouble to patients. Traditional Chinese medicine(TCM) has a variety of treatment methods based on syndrome differentiation and treatment, including internal treatment with TCM, acupuncture and massage, and other external treatment methods for comprehensive treatment, with significant effect. This study summarized the etiology and pathogenesis of CP/CPPS and found that western medicine cannot fully explain the etiology and pathogenesis of CP/CPPS. It was believed that CP/CPPS was mainly related to many factors such as special pathogen infection, voiding dysfunction, mental and psychological abnormalities, neuroendocrine abnormalities, immune abnormalities, excessive oxidative stress, pelvic diseases, and heredity. TCM believed that CP/CPPS was caused by damp heat, blood stasis, Qi stagnation, and poisoning and was closely related to the organs of the liver, spleen, kidney, lung, stomach, bladder, and meridians of Chong and Ren channels and three yin channels of the foot. In the treatment of TCM, multiple comprehensive treatment plans are currently used, including internal treatment with TCM(decoction, proprietary Chinese medicine, and unique therapies of famous doctors), acupuncture and massage treatment, and other external treatment methods(rectal administration, topical application of TCM, and ear acupoint pressure). Comprehensive regulation has significant clinical efficacy and prominent characteristics of TCM, and it is worth clinical promotion. This study aims to provide a reference for clinical prevention and treatment of CP/CPPS and points out potential directions for future research in this field.

Objective: To analyze serum bile acid profiles in pregnant women with normal pregnancy, intrahepatic cholestasis of pregnancy (ICP) and asymptomatic hypercholanemia of pregnancy (AHP), and to evaluate the application value of serum bile acid profiles in the diagnosis of ICP and AHP. Methods: The clinical data of 122 pregnant women who underwent prenatal examination in Xuzhou Maternal and Child Health Care Hospital from June 2022 to May 2023 were collected, including 54 cases of normal pregnancy group, 28 cases of ICP group and 40 cases of AHP group. Ultraperformance liquid chromatography-tandem mass spectrometry was used to measure the levels of 15 serum bile acids in each group, including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), lithocholic acid (LCA), ursodeoxycholic acid (UDCA), glycolcholic acid (GCA), glycochenodeoxycholic acid (GCDCA), glycodeoxycholic acid (GDCA), glycolithocholic acid (GLCA), glycoursodeoxycholic acid (GUDCA), taurocholic acid (TCA), taurochenodeoxycholic acid (TCDCA), taurodeoxycholic acid (TDCA), taurolithocholic acid (TLCA) and tauroursodeoxycholic acid (TUDCA). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to screen differential bile acids. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of differential bile acids and combined indicators between groups. Results: (1) Compared with normal pregnancy group, the serum levels of LCA, GCA, GCDCA, GDCA, GLCA, UDCA, TCA, TCDCA, TDCA, TLCA, GUDCA and TUDCA in ICP group were significantly different (all P <0.05), while the levels of LCA, DCA, GCA, GCDCA, GDCA, GLCA, TCA, TCDCA, TDCA, TLCA, GUDCA and TUDCA in AHP group were significantly different (all P <0.05). Compared with ICP group, the serum levels of CDCA, DCA, UDCA, TDCA, GUDCA and TUDCA in AHP group were significantly different (all P< 0.05). (2) In the OPLS-DA model, the differential bile acids between ICP group and AHP group were TUDCA, TCA, UDCA, GUDCA and GCA, and their variable importance in projection (VIP) were 1.489, 1.345, 1.344, 1.184 and 1.111, respectively. TCA, GCDCA, GCA, TDCA, GDCA and TCDCA were the differentially expressed bile acids between AHP group and normal pregnancy group, and their VIP values were 1.236, 1.229, 1.197, 1.145, 1.139 and 1.138, respectively. (3) ROC analysis showed that the area under the curve (AUC) of TUDCA, TCA, UDCA, GUDCA and GCA in the differential diagnosis of ICP and AHP was 0.860, and the sensitivity and specificity were 67.9% and 95.0%, respectively. The AUC of TCA, GCDCA, GCA, TDCA, GDCA and TCDCA in the diagnosis of AHP was 0.964, and the sensitivity and specificity were 95.0% and 93.1%, respectively. Conclusions: There are differences in serum bile acid profiles among normal pregnant women, ICP and AHP. The serum bile acid profiles of pregnant women have potential application value in the differential diagnosis of ICP and AHP and the diagnosis of AHP.

Objective: To explore the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC) for unresectable hepatitis B-related intrahepatic cholangiocarcinoma(ICC). Methods: This is a retrospective controlled study. Data from 140 unresectable ICC patients who received HAIC treatment at Sun Yat-sen University Cancer Center from March 2015 to June 2023 were retrospectively collected, including 72 patients in the hepatitis B surface antigen(HBsAg)negative group (43 males and 29 females, aged (59.6±9.5)years(range: 34 to 81 years)), 68 cases in the HBsAg-positive group (48 males, 20 females, aged (53.4±11.4)years(range: 29 to 82 years)). HAIC treatment used the FOLFOX regimen combined with oxaliplatin, leucovorin,and fluorouracil. The differences in effects, prognosis,and adverse reactions between the two groups of patients after HAIC treatment were analyzed. All variables were expressed as categorical data. The χ 2 test or Fisher's exact probability method was used to compare between groups. The Kaplan-Meier method was used to draw survival curves. The difference of survival curve between groups were compared through the Log-rank test. Results: According to the Response Evaluation Criteria in Solid Tumors(RECIST) version 1.1,the objective response rate(ORR) of the HBsAg-negative group was 23.2%(16/69),and the ORR of the HBsAg-positive group was 40.3%(25/62). The difference in ORR between the two groups was statistically significant( χ 2 =4.459, P =0.035). According to the modified RECIST(mRECIST) criteria,the ORR of the HBsAg-negative group was 27.5%(19/69), and the ORR of the HBsAg-positive group was 45.2%(28/62). The difference in ORR between the two groups was statistically significant( χ 2 =4.410, P =0.036). The median progression-free survival(PFS) of the HBsAg-negative group and the positive group were 7.1 months(95% CI : 5.8 to 13.2 months) and 7.3 months (95% CI : 5.7 to 10.3 months), respectively, and the median overall survival(OS) were 16.3 months (95% CI : 12.5 to 33.9 months) and 15.9 months (95% CI : 9.2 to 20.7 months) respectively. There were no statistically significant differences in PFS and OS between the two groups (both P >0.05). The main serious adverse reactions of the two groups of patients included increased AST, increased ALT, thrombocytopenia,and neutropenia. There were no statistically significant differences in various adverse reactions between the two groups after HAIC treatment (all P >0.05). Conclusion: Patients with HBsAg-positive unresectable ICC are more likely to benefit from HAIC treatment.

A 34 year old female patient was scheduled to undergo surgical resection due to a "breast nodule". Preoperative examination revealed an activated partial thromboplastin time (APTT) of 66.2 seconds, coagulation factor Ⅺ activity (FⅪ: C) of 2%, and FⅪ antigen (FⅪ: Ag) of 40.3%. The patient and family members showed no abnormal bleeding symptoms. Diagnosed as hereditary coagulation factor Ⅺ deficiency. Genetic testing revealed that the F11 gene had a heterozygous nonsense mutation in exon 10, c.1107C>A (p.Tyr351stop), and a heterozygous missense mutation in exon 13, c.1562A>G (p.Tyr503Cys). The father and son were p Heterozygous carriers of Tyr351stop mutation, while the mother and daughter are p Heterozygous carriers of Tyr503Cys mutations. The in vitro expression results showed that p The Tyr351stop mutation resulted in a significant decrease in the transcription level of F11 gene, while p The Tyr503Cys mutation has no effect on the transcription level and protein expression level of F11 gene, but it leads to a significant decrease in the level of FⅪ:C in the cell culture supernatant.

Objective: To investigate the prospective association of sleep duration with the development of chronic obstructive pulmonary disease (COPD) in adults in Suzhou. Methods: The study used the data of 53 269 participants aged 30-79 years recruited in the baseline survey from 2004 to 2008 and the follow-up until December 31, 2017 of China Kadoorie Biobank (CKB) conducted in Wuzhong District, Suzhou. After excluding participants with airflow limitation, self-reported chronic bronchitis/emphysema/coronary heart disease history at the baseline survey and abnormal or incomplete data, a total of 45 336 participants were included in the final analysis. The association between daily sleep duration and the risk for developing COPD was analyzed by using a Cox proportional hazard regression model, and the hazard ratio ( HR ) values and their 95% CI were calculated. The analysis was stratified by age, gender and lifestyle factors, and cross-analysis was conducted according to smoking status and daily sleep duration. Results: The median follow-up time was 11.12 years, with a total of 515 COPD diagnoses in the follow-up. After adjusting for potential confounders, multifactorial Cox proportional hazard regression analysis showed that daily sleep duration ≥10 hours was associated with higher risk for developing COPD ( HR =1.42, 95% CI : 1.03-1.97). The cross analysis showed that excessive daily sleep duration increased the risk for COPD in smokers ( HR =2.49, 95% CI : 1.35-4.59, interaction P <0.001). Conclusion: Longer daily sleep duration (≥10 hours) might increase the risk for COPD in adults in Suzhou, especially in smokers.

Atmospheric PM 2.5 samples were collected in Heze, Shandong Province, from a total of three sampling sites at Heze College, Huarun Pharmacy, and a wastewater treatment plant between October 15, 2017 and January 31, 2018, to determine the concentrations of 21 metal elements in PM 2.5 using inductively coupled plasma mass spectrometry (ICP-MS). The degree of elemental enrichment was also discussed, the health risks and potential heavy metal ecological risks were assessed. The results showed that ρ (PM 2.5 ) ranged from 26.7 to 284.1 μg·m -3 at the three sampling sites during the sampling period, and the concentration values did not differ significantly, all of which were at high pollution levels. The highest concentrations of K were found in the three sampling sites, accounting for 31.03%, 39.47%, and 38.43% of the total, respectively, mainly due to the high contribution of biomass burning in autumn and winter in Heze, a large agricultural city. The highest concentrations of Zn, 89.70, 84.21, and 67.68 ng·m -3 , were found in the trace elements at the three sampling sites, respectively. The enrichment factor results showed that the enrichment factor values of Zn, Pb, Sn, Sb, Cd, and Se were higher than 100, among which the enrichment factors of Cd and Se were higher than 2 000 and 4 000, respectively, which were significantly influenced by anthropogenic activities and might have been related to industrial production, metal smelting, road sources, and coal combustion emissions. The health risk results showed that there was some potential non-carcinogenic risk (HQ>0.1 for children and adults) for As and a combined potential non-carcinogenic risk (HI>0.1) and some potential carcinogenic risk (CRT>1×10 -6 ) for both children and adults at the three sampling sites. There was a more significant carcinogenic risk (CRT>1×10 -4 ) for adults at the wastewater treatment plant, and the slightly higher carcinogenic risk for adults than that for children may have been related to the longer outdoor activity and higher PM 2.5 exposure for adults. The elements with the highest potential ecological risk values were Cd, As, and Pb, with Cd exhibiting a very high potential ecological risk that should be taken seriously. All three sampling sites showed a very high combined potential ecological risk, with the intensity spatially expressed as Heze College>Huarun Pharmacy>wastewater treatment plant.

Using coconut shell and boric acid as raw materials， a new boron-doped coconut shell mesoporous carbon material （B-CSC） was prepared using a simple one-step pyrolysis method for efficient adsorption and removal of tetracycline pollutants in water. The effects of pyrolysis temperature and boron-carbon mass ratio on the adsorption performance under key preparation conditions were systematically studied， and their microstructure and physicochemical properties were characterized using a specific surface area and pore size analyzer （BET）， field emission scanning electron microscopy （SEM）， X-ray photon spectroscopy （XPS）， Raman spectrometer （Raman）， and Zeta potentiometer （Zeta）. The effects of initial pH， different metal cations， and different background water quality conditions on the adsorption effect were systematically investigated. Combined with material characterization and correlation analysis， the enhanced adsorption mechanism was discussed and analyzed in depth. The results showed that one-step pyrolysis could incorporate boron into the surface and crystal lattice of coconut shell charcoal， resulting in a larger specific surface area and pore volume， and the main forms of boron introduced were H 3 BO 3 ， B 2 O 3 ， B， and B 4 C. The adsorption capacity of B-CSC to tetracycline reached 297.65 mg·g -1 ， which was 8.9 times that of the original coconut shell mesoporous carbon （CSC）. At the same time， the adsorption capacity of B-CSC for rhodamine B （RhB）， bisphenol A（BPA）， and methylene blue （MB）， common pollutants in aquatic environments， was as high as 372.65， 255.24， and 147.82 mg·g -1 ， respectively. The adsorption process of B-CSC to tetracycline was dominated by physicochemical interaction， mainly involving liquid film diffusion， surface adsorption， mesoporous and microporous diffusion， and active site adsorption， and H 3 BO 3 was the main adsorption site. The adsorption strengthening mechanism mainly reduced the chemical inertness of the carbon network and enhanced its π-π interaction and hydrogen bonding with tetracycline molecules.

Based on the typical city survey data and statistics of Guangdong Province， a 2018-based 3 km×3 km gridded greenhouse gas emissions inventory was developed for Guangdong Province using the combination of top-down and bottom-up emission factor methods. The inventory covered the CO 2 ， CH 4， and N 2 O emissions from energy， industrial processes， agriculture， land use change and forest， waste management， and indirect sources. The results showed that estimates for CO 2 ， CH 4 ， and N 2 O in Guangdong Province for the year 2018 were 8.5×10 8 ， 1.9×10 6 ， and 1.1×10 5 t， respectively， and 8.5×10 8 ， 4.0×10 7 ， and 3.4×10 7 t by equivalent carbon dioxide， totaling 9.2×10 8 t. CO 2 was the main greenhouse gas in Guangdong Province， accounting for 92.0% of the total emissions. Energy and indirect sources were the main emission sources， accounting for 77.9% and 7.6%， respectively， totaling 85.5%. Spatial distributions illustrated that most grids were greenhouse gas emissions， whereas some others were greenhouse gas sinks； the greenhouse gas emissions were distributed mainly in the Pearl River Delta region and had certain characteristics of distribution along the road network and channels. The greenhouse gas grids of high emission were mainly the locations of high energy-consuming enterprises such as large power plants， steel mills， and cement plants.

Background: Patient safety culture is an indicator of healthcare quality and a topic of global importance in medical care., Purpose: In this study, the attitudes towards patient safety culture of nursing staff working in the emergency, intensive care, and general wards are compared before and during the COVID-19 pandemic., Methods: A retrospective research design was utilized and an anonymous questionnaire survey conducted on the Taiwan Patient Safety Culture Survey web-based platform system was used to collect the data. The survey was administered in a regional hospital in northern Taiwan between 2018 and 2020. The 1,540 nursing personnel who participated in this study worked in the emergency, intensive care units, or general adult ward. The analysis focused on assessing participant attitudes towards patient safety culture in terms of both the overall score and sub-dimensions., Results: The participants were mostly female and between 21 and 30 years old. A majority had completed a diploma or university education. The two analyses revealed the highest and lowest average scores were earned, respectively, in the "teamwork" and "resilience" dimensions of patient safety culture. In 2020, the average scores for all dimensions were lower than in 2018, and the average scores for the emergency and critical care group were lower than those for the general adult ward group. Sub-dimension analysis showed that the general adult ward group earned significantly higher scores in "teamwork" across all three sub-dimensions compared to the emergency and critical care groups. The general ward group exhibited the most significant score decline between the two surveys., Conclusions / Implications for Practice: Overall scores were found to have decreased during the COVID-19 pandemic period (2020). Notably, emergency and intensive care nurses earned consistently lower scores, likely due to the severity of patient conditions and increased pandemic-related workloads and stress. "Resilience" scores were the lowest among all nursing staff, with the most significant drop seen in general ward nurses. Enhancing nursing staff education and training as well as addressing their psychological well-being will be crucial to improving patient safety culture attitudes. Managers should provide infection control, resilience training, and psychological counseling to help nurses manage the challenges posed by infectious diseases effectively and enhance patient safety culture.

Background & Problems: Hemodynamic monitoring is an important part of nursing care in the intensive care unit. Recent advances in medical technology and the diversification of intensive care equipment have increased the variety of instruments used in clinical hemodynamic monitoring. Many nurses who use new hemodynamic monitors are not familiar with instrument care, resulting in patient safety incidents caused by nurses not identifying warnings of hemodynamic data change and notifying doctors to provide treatment. The accuracy of hemodynamic monitoring care in our ward of 74.0% motivated this improvement project., Purpose: To improve the accuracy of hemodynamic monitoring care to 98.3%., Resolution: Conduct educational training and plan professional education; establish an audit system to regularly monitor the accuracy of nursing care; provide tips to make the operation manual easier to read and understand; establish mobile learning to make learning immediate and more accessible; hold instrument operation practice sessions to improve nursing staff proficiency; monitor and upload data to the hospital information system., Results: After the improvement project, the accuracy of hemodynamic monitoring care increased to 98.7%., Conclusions: The impact achieved met expectations, and the improvement project will be extended to other intensive care units in the hospital. Our nurses are now more familiar with the operation methods and the significance of monitoring values and interpretation of data. Also, when a value changes or becomes abnormal, they immediately notify the doctor for further evaluation and interventions to improve patient safety.